These are my reflections on those Scriptures that God has used to comfort me as I have travelled through the "valleys of Shadow of death." I am hoping that they will comfort those fellow-travelers who are going through the wilderness of life. At times, I will also write blogs relevant to mental illness, particularly as it relates to issues of faith, theology and community. All Scriptures used here will be from New American Standard Bible, unless otherwise specified.

Depression and Desperate Treatments

Depression is a soul-wrenching, dark, and dreadful illness. Those suffering from depression, encounter such despair and hopelessness that makes them desperate for solutions in search of healing. The cause of depression is not yet known. Most people have bought into the medical narrative of a broken brain. However, the rates of depression have been on the rise in the western world in a troubling fashion. There are many hypotheses about the cause of this increase. Some “speculate that depression may be another “disease of modernity,” like obesity.” Some believe it is the result of a loss of identity, loneliness, or a sense of failure in a world that is consumed by material success. Many believe it is the outcome of traumatic life experiences and a sense of deep loss. Others, while acknowledging that life experiences are a definite trigger, believe the root of the illness is spiritual, and it touches deep into one’s soul-struggle to conquer all that is blocking it from wholeness.

Regardless of the etiology, depression is a disabling illness that makes one feel swallowed in a deep hole, and desperately in need of a rescue.

Unfortunately, in our culture, first and foremost, that rescue comes from the medical field. The focus is mostly on the brain and not as much on the soul. However, antidepressants, though helpful at times, have not been effective in a good number of cases. There are also a lot of valid questions in relation to the side effects of these drugs.

Recently, psychiatric literature has been buzzing with a new treatment using ketamine. This is a very controversial drug, with serious side effects, which enjoys claims of immediate efficacy for depression. I am referencing an article in this post that is supportive of ketamine, but ironically, comes across very troubling for any attentive reader. It promotes the benefits of Ketamine, presenting them with a shining light, but the truth can easily be found between the lines. Ketamine, is not currently FDA-approved to treat depression, but it is being prescribed off-label by many psychiatrists.

My hope is that, regardless of their desperation, people with depression would subscribe to ketamine treatment with open eyes and full knowledge of the benefits and the risks. I believe this is a useful article for those who might be considering ketamine as a potential treatment for depression. The following is an excerpt:

Modern psychiatry has made amazing developments in the treatment of mental illness with drug therapy. Just a short time ago, a patient whose depression was resistant to treatment through therapy and medication had the option to try electroconvulsive therapy or ECT. (Some patients were forcibly electroshocked without their consent, which is a whole other ball of wax). ECT is incredibly controversial and not for the faint of heart. Today there may be a new solution for patients who find that their depression does not respond to therapy or FDA-approved drug treatments.

This new solution is not quite as controversial as ECT but there are concerns about the use of this drug to treat depression. How worried should we be about introducing ketamine as a treatment for depression?

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Ketamine is commonly used in veterinary medicine to tranquilize or euthanize animals and it is even used to tranquilize humans as well, typically for surgical procedures. It is also sometimes used as a date-rape drug and is probably best known by its nickname: “Special K.” Ketamine a psychedelic drug like LSD or mushrooms, which can cause hallucinations in addition to general euphoria. It’s typically found at raves and parties, but it does have several medical applications. While its medical use comes with few side effects, ketamine abuse can lead to amnesia, incontinence, and death. Unsurprisingly, it is also highly addictive.

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As Dr. Matthew explains, ketamine works in hours, not weeks. For some patients, it could literally be life-saving. There is, however, a risk to the use of ketamine as a treatment. Like all medicines, there are potential side effects. In ketamine’s case, the main danger is the likelihood of addiction. That potential certainly does exist, much like opioid pain-killers have dramatically increased the number of people addicted to pain medication, often spurring them to try heroin as well.

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Ketamine has been used as an anesthetic since the Vietnam War, but it can also cause hallucinations and lead to addiction. It was made a Schedule III substance in 1999, putting it on par with LSD in the eyes of the law. This is why many companies are seeking to create drugs that are similar to ketamine in their effect on depression but without the high. Both a nasal spray and a pill are being explored by two different companies as potential treatment options. These drugs are all still currently in the clinical trial phase, so it could be years before any of them are approved for depression treatment.

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Ketamine already has an established track record in the medical community as a drug that can be used to stop physical suffering. It is actually the go-to drug in emergency rooms for children with serious pain. Ketamine can cause hallucinations and an “altered” sense of reality, even at the low doses that are used to treat adults with depression. But most of the negative consequences, such as hallucinations and addictive behavior, come from the drug being used in much higher doses and not under doctor supervision. The risk is still there but it has already been proven to be a risk that doctors are willing to take in other medical situations.

The problem with ketamine is much like the problem with opioid painkiller abuse. The opioid epidemic comes not from having and using opioids, when they are needed, but from not treating opioids in a way that acknowledges how dangerous they can be. It was caused by patients, doctors and drug companies that advertised, falsely, that the likelihood of addiction is low, pushing painkillers as the wave of the future. (If you’re interested in the institutional contribution to the rise of the opioid epidemic take some time to watch Frontline’s “Chasing Heroin”). But the lessons to be learned from the opioid epidemic are not to avoid new drugs that have addictive potential. Almost all powerful drugs have the potential for addiction and most medications have potential side effects. It’s a cautionary tale that speaks to the need to monitor treatment and remove financial incentives for over-prescribing and over-promoting new wonder drugs. We should approach the use of ketamine carefully, but not deny its potential usefulness because it can be abused.

In my view, it is irresponsible, in the absence of FDA approval, to even recommend ketamine as a viable treatment for depression. Our society has been suffering severely from the opioid epidemic and its disastrous consequences for so many families. When a favorable article, such as this, asserts that “Ketamine can cause hallucinations and an “altered” sense of reality, even at the low doses that are used to treat adults with depression,” and that it is “highly addictive,” I would seriously hesitate to recommend this as a treatment of choice for any of my loved ones!

Before we subscribe to such an invasive and controversial treatment, we should pause and remember that not all tragedies, sorrows and holes within our souls can be addressed by drugs.

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In the Fellowship of His Suffering: A Theological Interpretation of Mental Illness – A Focus on “Schizophrenia”

About Elahe Hessamfar

ELAHE HESSAMFAR is a former business executive and has a PhD in Divinity from the University of Aberdeen in Scotland. She has an MA in biblical studies from the Reformed Theological Seminary, an MS in computer science from the George Washington University, and a BS in electrical engineering from the University of Kansas.

Comments

Ketamine has been used for the past 50 years for millions of people worldwide as an anaesthetic, to treat severe chronic pain and more recently to help people suffering from treatment-resistant depression. With careful patient selection and monitoring and the use of ketamine as part of a comprehensive treatment plan, issues with dependence and addiction are exceedingly rare. Any treatment involves balancing benefits against risks and for chronic severe conditions the balance tilts heavily to the benefit side. Further information can be found in the recently released book “Ketamine for Depression.”

The self serving pious nature of the author’s comments are not based on facts but hysteria. No FDA approval will ever be forthcoming on Ketamine when no pharma will ever invest years and millions into an old drug that is not patentable, I personally had 7 ketamine infusion treatments in New York City over 7 days recently, administered by a very kind and caring anesthesiologist, after travelling 500 miles to his clinic and gladly paid $3000US for the benefit of these transfusions which are unavailable in Canada (unless one is among a lucky few that get into small study by a hospital researcher – equivalent to getting hit by lightning or winning a lottery). I came to the NYC clinic as a broken and non-functioning man – I had spiralled to be lying down at home on a couch or in bed for many months prior to the ketamine treatments. Before trying ketamine, a combination of MBCT, cognitive therapy, rTMS (30 treatments), 100mg Pristiq and 15mg Remeron per day (after years of SSRI, SNRI and tricyclic antidepressants), did not relieve the devastating toll on my life and my family. I. have suffered from MDD and GAD for most of my 57 years and have been prescribed almost every known pharmaceutical known to mankind without success. After 2 ketamine infusion treatments (at .6mg/kg) over 65 minutes, I was catapulted into remission. For those that insist I was the happy recipient of some placebo effect, I was absolutely positive that the infusions wouldn’t work, especially since the first day produced zip. I was devastated and my doubts were sky high but the calming effect after the second was immediately obvious to me. It was as if a switch had been turned off – all the ruminating and anger over my helplessness stopped. I could see all the down escalators but, for once, I didn’t fall all over myself careening down the nearest one and could just keep on walking by unaffected by negative circumstance. This is not a “happy pill” type of infusion. I did not suddenly turn into a comedian or start smiling from ear to ear – just felt more normal without the black clouds and despair hanging over my head. I could not believe that I suddenly felt at peace after so many years of utter misery. Ketamine is not a miracle cure and I still need to take meds for my excess anxiety, but at least I’m no longer crippled from the moment I wake up to when I fall asleep. I did not enjoy the infusion procedures in any way and pretty well grew to dread the last ones due to the (very temporary) dissociative side effect which I found unappealing and just something that I had to get through (with my own kind of music to distract me) for the end result. My doctor told me that the dissociative effect may facilitate the lifting of the depression and so I endured it. I also had a negative experience during the 3rd transfusion where the ketamine infusion felt too fast for my liking and I had to stop the infusion to demand a slower drip. I, along with almost all patients administered by this method, will never be a K-abuser and based on all that I have researched, this is a slander by those who have no personal experience with subanesthetic low dose ketamine. Elahe, don’t say another word until you walk in the shoes of a chronic depressive who was thinking that there was no point to life anymore because all the best days are over. You are spreading nonsense and fear. More infusion clinics need to be opened and more patients need access to ketamine without having to max out their credit cards. I will need to go back, just as diabetes patients need to get their insulin on a frequent basis to live semi-nomal lives. Read some of the many studies and become knowledgeable. Please direct your dismay to the K-party crowd who are taking irresponsible doses to get high, not this beleaguered crowd of patients!

I believe the author needs to differentiate between clinical and spiritual depression. She is too hard on the drug Ketamine. She needs to do more research on how it is a great breakthrough in the mental health arena of treatment. If someone is desperate to get rid of depression they will try anything within reason to get it out of their life.
When it comes to understanding mental illness, Robyn and Steve Bloem’s book, Broken Minds Hope for Healing When You Feel Like You’re Losing It has made a difference in evangelical churches everywhere. It is a story of a couple’s dealing with Steve having the first occurrence of aclinical depression when he was twenty nine years old. It is a biblical, technical and clinical look at mental illness.